The indication of transcatheter aortic valve replacement (TAVR) is shifting toward younger and lower-risk patients. Data on the latest intra-annular TAVR devices are scarce. This study comparesthe short-term clinicaloutcomes, hemodynamic performance, and post-procedural multi-detector computed tomography (MDCT)findings for two intra-annular TAVR devices in Japan: SAPIEN 3 Ultra RESILIA (S3UR) and Navitor.

Of the 286 patients whounderwent TAVR between May 2022 and October 2023 at our center, we enrolled 97consecutive patients who received either S3UR or Navitor and underwent intraproceduralinvasive hemodynamic assessment and postprocedural MDCT. 

Among the 97 patients (median age, 86 years [interquartilerange: 81–89]), the basic characteristics were similar. Valve Academic Research Consortium-defined technical success was achieved similarly in all cases. Despite of smaller annulus, Navitor demonstrated improved post-procedural hemo dynamic performance(mean pressure gradient by TTE, 9.2 [7.3–13.6] mmHg vs. 7.5 [5.9–9.5] mmHg,p=0.006; by invasive measurement 5.1 [3.4–7.7] mmHg vs. 5.3 [3.2–7.9] mmHg, p=0.986),however severe prosthesis-patient mismatch was noted similarly between the two devices. Mild paravalvular leak (PVL) (24.5% vs. 54.5%, p=0.002) and permanent pacemaker implantation (5.7% vs. 27.3%; p=0.003) were more frequent with the Navitor,despite no moderate-severe PVL in each group. The incidence of hypo-attenuated leaflet thickening (HALT) detected by MDCT was similar between the two groups.

Bothintra-annular valves demonstrated excellent hemodynamic performance with minimalPVL after TAVR. The incidences of HALT inboth devices were comparable.Navitor demonstrated better hemodynamic performance and ahigher rate ofpacemaker implantation rather than S3UR.